Breast lift with or without augmentation - what determines it?

Some plastic surgeons prefer to to a lift and augmentation in 2 stages as as been recommended for you, but many including myself feel it is usually best to do them together. The implant size is determined by measurements such as the base diameter of the breasts and patient choice. The implant size influences the type of lift that is needed so it doesn't make sense to me to do the lift first.

I agree with Dr. Baxter that there are different approaches to the breast that needs a lift and an implant. My approach is to perform these procedures at the same time with various implant sizes. I would recommend you seek consultation with a few board-certified plastic surgeons and see who you feel the most comfortable with in their approach.

I hope this helps.

Dr. Edwards

Different surgeons will have different approaches. While some prefer doing a lift and placing implants in 2 stages, many plastic surgeons with extensive experience performing breast surgery would place the breast implants at the time of the lift in the appropriate patient. The optimal size of the breast implant can be determined pre-operatively and either saline or silicone gel implants may be an option.

I would suggest that you get a second opinion from a plastic surgeon that you are comfortable with and one that you trust and listen to his or her advice. The surgeon should be certified by the American Board of Plastic Surgery and ideally a member of the American Society for Aesthetic Plastic Surgery (ASAPS). You should discuss your concerns with that surgeon in person.

Robert Singer, MD FACS
La Jolla, California

Breast Lift With Or Without Augmentation - What determines whether you need an augmentation with a breast lift is whether you want superior fullness and/ or you do not have any residual breast tissue. If you want to move the nipples upward and reshape the breast without any superior fullness, then the breast lift alone is sufficient. If you want some fullness then an implant is usually recommended. This should be done in the hands of a Board Certified Plastic Surgeon with expertise in Breast Surgery.

A breast lift and an augmentation are designed to do somewhat different things. A breast augmentation will make the breast larger but doesn't significantly alter fundamental characteristics of the breast such as nipple position and the amount of breast sag. A breast lift is designed to change these shape issues while an implant can contribute to fullness in the upper portion of the breast and the amount of projection the breast has and of course breast size/volume. When combining both procedures together the process becomes complex. The breast lift necessarily eliminates some of the breast skin in order to allow repositioning of the nipple on the breast mound. Thus the skin area of the breast (think of this as surface area) is also reduced. When an implant is placed, the volume of the breast goes up. A breast with a larger volume has more surface area and requires more skin to cover it. Thus one procedure is reducing skin coverage while the other is requiring more skin to cover the volume of the breast. If the situation arises where the larger volume of the breast after the implant requires more skin than exists after the breast lift, it can be difficult to close the incisions without excessive tightness. Excessive tightness can cause the wound to come apart or develop excess scarring. The smaller the breast is before the lift, the more likely this scenario becomes. It is also very difficult to predict exactly what size implant will fit into a breast before performing the breast lift.; although, after having done a great many of these it is possible to get a feel for what will work and what won't.

The approach recommended to you is not unreasonable. Further, it would give you the opportunity to specify a breast implant size that ultimately will satisfy your goals. Be aware however, that there are trade-offs associated with choosing larger implants than what is recommended by your plastic surgeon. For the best result seek the consultation of a plastic surgeon certified by the American Board of Plastic Surgery. They have a website listing all the certified plastic surgeons. Members of the American Society for Aesthetic Plastic Surgery will all be board certified in plastic surgery and have demonstrated an interest and competence in cosmetic plastic surgery as well.